Alcohol, Liver Disease, and Peripheral Arterial Disease: Epidemiology, Mechanisms, and Clinical Implications

Peripheral arterial disease (PAD) is a major vascular complication associated with significant morbidity and mortality. While traditional cardiovascular risk factors such as smoking, hypertension, and diabetes are well established, emerging evidence suggests that alcohol consumption, alcoholic liver disease, and metabolic-associated steatotic liver disease may also contribute to PAD risk. This review synthesizes current epidemiological evidence linking alcohol intake, alcoholic liver disease, and metabolic-associated steatotic liver disease to PAD and explores potential mechanisms, including atherosclerosis, endothelial dysfunction, chronic inflammation, dyslipidemia, and coagulation abnormalities. Observational studies suggest a possible protective effect of light-to-moderate alcohol consumption though genetic studies challenge this notion. In addition, alcoholic liver disease and metabolic-associated steatotic liver disease are increasingly recognized as contributors to systemic vascular dysfunction and PAD progression. In conclusion, given the rising burden of liver disease, it is crucial to determine whether PAD screening is warranted in patients with high-risk alcoholic liver disease and metabolic-associated steatotic liver disease. Addressing modifiable risk factors and optimizing pharmacological interventions may help mitigate PAD risk. Future research should focus on longitudinal studies, sex- and ethnicity-specific differences, and omics-based approaches to refine risk prediction, early detection, and targeted interventions.